Accommodative intraocular lens and method of improving accommodation

ABSTRACT

The present invention provides an accommodative intraocular lens (AIOL) system and method for improving accommodation with an intraocular lens. The method involves insertion into the capsular bag of a flexible optic holder comprising a plurality of haptics configured to allow the capsular bag to be sectioned at regular intervals following fusion of the capsular bag. The haptics of the optic holder are designed to allow maximum fusion of the anterior and posterior leaves of the capsular bag following placement of the optic holder in the capsular bag. Following introduction of the optic holder into the capsular bag, the natural or assisted process of fibrosis/fusion of the capsular bag occurs, thereby sealing and securely capturing the haptics within the capsular bag. Subsequently, several cuts are made in the fibrotic capsular bag at intervals between haptics, allowing the haptics to move independently, thereby effectively restoring some of the flexibility that the capsule possessed prior to fibrosis and restoring some of the zonular force on the capsule.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a U.S. Non-provisional application thatclaims the priority of U.S. provisional application No. 61/353,273,filed Jun. 10, 2010 and U.S. provisional application No. 61/368862,filed Jul. 29, 2010. The contents of those applications are herebyincorporated by reference into the present disclosure in their entirety.

TECHNICAL FIELD

The present invention relates generally to intraocular lenses. Moreparticularly, the present invention relates to accommodative,intraocular lens systems and methods for improving accommodation.

BACKGROUND INFORMATION

Under normal conditions, a healthy human eye focuses on near and distantobjects by contraction and relaxation of the ciliary muscle therebycontracting and releasing the tension on the zonules in the eye. Thecontraction of the ciliary muscle releases zonular tension (accomodativestate) and allows the lens to alter to a more globular or sphericalresting shape. The relaxation of the ciliary muscle increases tension onzonules and elastic forces in the eye tissue overcome the inherent lenselasticity and result in stretching the lens equator and flattening thelens curvature (un-accomodative state).

In certain instances, for example when age-related opacification of thelens (cataract) interferes with vision, the natural crystalline lens ofthe eye needs to be removed. Generally, the natural lens is replacedwith an artificial one, for example, an intraocular lens (IOL).Unfortunately, conventional IOLs, even those that profess to beaccommodative, may be unable to provide sufficient spatial displacementof the lens along the optical axis to provide an adequate amount ofaccommodation for near vision.

In conventional extracapsular cataract surgery, the crystalline lensmatrix is removed by phacoemulsification through a curvilinearcapsularhexis leaving intact the thin walls of the anterior andposterior capsules, together with zonular ligament connections to theciliary body and ciliary muscles. An intraocular lens is then placed inthe capsular bag, which collapses around the IOL.

Conventional single-optic accommodative intraocular lenses (AIOL) relyon the interaction of the ciliary muscle with the zonule and capsule toinduce movement of the optic of the AIOL along its optical axis.Typically, the AIOL is secured within the capsular bag by two or morehaptics that translate the radial stretching force exerted on thecapsular bag by the zonules in an attempt to achieve the desired axialdisplacement of the optic.

However, during the post-implantation fibrotic healing process, theanterior capsule fuses with the posterior capsule to form a rigidcapsular disc. Loss of elasticity of the capsular disc results andconstrains the amount of movement that can be generated by the zonularforce or elastic recoil of the intraocular lens and therefore, leads toa decrease in the amount of axial displacement of the lens that can beachieved.

Various lens systems have been designed to address this loss ofaccommodation. Passive-shift single-optic lenses, the only accommodativelens currently marketed, were designed to move forward under ciliarymuscle contraction. Accommodation in these systems, however, remainslimited by the loss of elasticity in the post-fibrotic capsule. Even thelimited amount of accomodative amplitudes generated by these lensesimmediately after surgery is lost within the first few weeks or monthafter surgery as capsular fibrosis ensures.

Accommodative lens designs with single or multiple optic lens assemblieshave been disclosed, for example, in U.S. Pat. Nos. and U.S. applicationnos. 2009/0125106, 2005/0209692, 2007/0156236, 2009/0005866,2007/0005136, 2009/0248154. Dual optic lenses retain the problem ofcapsular fibrosis and loss of amplitude/movement even though they arereported to provide a significant amount of accommodation. However,concerns about possible long-term formation of interlenticularopacification remain.

More recently, a lens systems that employs an active-shift mechanismusing repulsive mini-magnets as a means of making accommodationpartially independent of the zonules and mechanical properties of thecapsular bag was disclosed (see U.S. Pat. Application Nos. 2009/0204210and 2007/0118216. Still other methods of achieving accommodation includeintroduction of a polymerizable fluid with a desired refractive indexinto the capsular bag (lens refilling). Extensive investigation into thefeasibility of these methods is still needed.

U.S. Publication No. 2009/0234449 discloses an intraocular lenscomprising an accommodating element that is in contact with asubstantial portion of the zonular region; the accommodating element ispositioned relative to optical element and configured to cooperate withthe ciliary muscle, the zonules and/or the vitreous pressure in the eyeto effect a shape change to the optical element. According to the '449publication, prior art multiple lens systems can be cumbersome and alsorequire an axial displacement unachievable with a collapsed capsular bagand resulting ineffective accommodative mechanisms.

The need remains therefore, for an intraocular lens system and aneffective mechanism for improving the accommodative capacity of an IOLfollowing implantation. None of the current lens concepts take intoaccount that the devitalized capsular bag after cataract surgery changesits physical properties from an elastic sphere to a contracted rigiddisc.

SUMMARY OF THE INVENTION

Briefly, the present invention provides an intraocular lens system andmethod for improving accommodation that remedies the loss of axial andcentrifugal movement caused by shrinkage and loss of flexibility of thecapsular bag following implantation of conventional lens systems. A lenssystem of the present invention includes a flexible optic holdercomprising a plurality of zonular capture haptics, in particular,regularly-spaced haptics that are adapted to allow or facilitate fusionof the capsular bag following placement of the optic holder within thecapsular bag and ultimately to permit the sectioning of the fusedcapsular disc. During fusion, each haptic becomes permanently entrappedin its respective capsular disc section; sectioning frees adjacenthaptics from each other; each haptic can, therefore, move independentlyin response to ciliary muscle and zonular forces on the capsule. Theaction of the zonular capture haptics can be translated to differenttypes of optics suited to provide accomodative amplitude. The restoredelasticity of the present accomodative IOL system, which allows theoptic to return to a resting state when zonular tension is released, isprovided by angulated haptics which straighten under zonular tension, bythe elasticity of the optic or a combination of both.

The novel optic holder of the invention is implanted in two stages:first, the optic holder (which may or may not include an integral opticat this stage) is implanted and sufficient time is allowed for fusion ofthe anterior and posterior leaves of the capsular bag around theimplanted device. In a second stage, the fused and fibrosed capsular bagis sectioned at regular intervals determined by spaces between thehaptics of the optic holder, to reduce its rigidity, thereby restoringsome of the movement lost during fusion of the capsule, fibrosis andformation of the capsular disc. The force of the zonules is uniformlytransmitted to the lens via the entrapped haptics.

Unless it is already an integral part of the zonular capture haptic, theoptic of the lens system may be inserted into the haptic during a secondstage of the procedure. Any mechanical means or chemically-inducedtensioning or positioning of the haptic/optic complex, which may havebeen employed to control the accomodative state of the haptic-lenscomplex during the fusion and contraction of the healing capsular bagwould be removed at this juncture.

In one aspect, therefore, the present invention relates to a method forimproving accommodation with an intraocular lens (IOL) system, themethod comprising introducing a flexible optic holder with zonularcapture haptics into the capsular bag of an eye of a subject andallowing a period of time sufficient for fibrosis of the capsule tooccur so that the zonular capture haptics are captured within the fusedcapsule. During this time the eye may be maintained in either anunaccommodative or accommodative state by administration of an agent toinhibit or induce accommodation, for example, atropine or pilocarpine,respectively. Alternatively, mechanical means may be used to retain thecapsule in a flattened and maximally (unaccommodated) or minimally(accommodated) expanded configuration. Apposition of the anterior andposterior leaves of the capsule to facilitate fusion may also beachieved by introduction of an air bubble anterior to the capsular bag.Other mechanical, chemical or biological means may be utilized toenhance the adhesion of the anterior and posterior capsule.

In a second stage, cuts are made in the fibrotic capsular disc atsectioning intervals between the zonular capture haptics of the opticholder. In some embodiments, during this second procedure, the optic isinserted into the holder.

In a related aspect, the invention relates to a flexible optic holdercomprising an arrangement of zonular capture haptics that permits 1)complete integration of the haptics during fusion of the capsule to forma capsular disc and 2) sectioning of the fused capsular disc. The opticholder comprises a plurality of hollow closed-loop or fenestratedhaptics that extend outwardly from the center of the optic holder todefine a disc that is roughly coextensive with the capsular disc andprovides a template for sectioning of the disc following fusion. Theoptic holder of the invention is configured to provide support for anoptic, to facilitate fusion and fibrosis of the capsular disc, to allowsectioning of the fused capsular disc and to uniformly translate forcefrom the zonules to the optic.

In one aspect, the invention relates to an intraocular lens system forimplantation in a capsular bag of an eye, comprising 1) a flexible opticholder comprising a plurality of haptics that extend outwardly from thecenter of the optic holder with sectioning regions therebetween wherethe haptics define a disc that is roughly coextensive with the capsulardisc; and 2) an optic adapted to fit into the optic holder. Theintraocular lens system is configured to be coextensive with thecapsular bag when placed therein and to become fixed within the capsularbag once fusion of the capsular bag has occurred.

The optic holder comprises a plurality of regularly spaced haptics, forexample, from 3 to 120 haptics. In an alternate embodiment, the flexibleoptic holder comprises a single haptic with a fenestrated structure orof a surgical mesh or similar woven material with holes sufficientlylarge to allow contact and fusion of the anterior and posterior capsulethrough the fenestrae or holes. The haptics are spaced at regularintervals, with the space between adjacent members defining a sectioningregion.

These and other objects, features and advantages of this invention willbecome apparent from the following detailed description of the variousaspects of the invention taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1a and 1b are illustrations of one embodiment of a flexible opticholder of the invention; FIG. 1b shows the optic holder in its expandedform.

FIGS. 2a and 2b show one embodiment of the invention inside the capsuleof an eye prior to (2 a) and following sectioning of the capsular bag (2b).

FIG. 3 is a schematic showing the position of the optic in theunaccommodated (top) and accommodated (bottom) states. Duringaccommodation, the optic moves anteriorly (shown as downward); thedotted line indicates the position to which the optic returns when inthe unaccommodated position.

FIG. 4a shows an alternate embodiment of the optic holder in thecapsule, prior to sectioning, in which an optic has been secured. FIG.4b shows the position of the haptics relative to the optic duringaccommodation; FIG. 4c shows the relative positions of the haptics andthe optic under zonular tension (un-accomodative state). A staple-likeretainer, for stabilizing the optic during fusion is also shown.

FIG. 5 shows an embodiment in which a snap-like fastener is used asoptic attachment means for securing optic in optic holder; 5 b shows therelative positions of the haptics and optic attachment means when theoptic holder is fused within the capsule; 5 c shows the relativepositions of the haptics and optic during accommodation followingsectioning of the capsular disc.

FIG. 6a shows anterior and posterior views of a dual-optic system inwhich two optic holders (black and gray) are used; FIG. 6b shows theposition of the two optics during accommodation.

FIG. 7a shows an embodiment of the dual-optic system in which optics arean integral part of the optic holders; the positions of the two opticsduring accommodation (7 b), and unaccommodation (7 c) are shown.

FIG. 8 is an embodiment of an optic holder with a single dough-nutshaped haptic made of a woven or mesh-like material that can be cut, forexample, with surgical scissors. A side view of the optic/optic holderis shown with a retainer, mechanical means for maintaining the minimumdiameter (maximum contraction) of the capsular bag during fusion.

FIG. 9a shows an embodiment of the optic holder with an integratedflexible optic that approximates the natural lens; in the absence ofzonular tension (accommodation), the optic is more spherical (9 b) thanwhen it is in the unaccommodated state (9 c).

FIG. 10 is a photograph of an experimental model of a haptic design ofthe invention.

FIG. 11 includes a computer generated image and a schematic toillustrate the relative positions during accommodation of the hapticsand a non-flexible optic using the optic holder of the present inventionafter the fused capsular bag has been sectioned.

FIG. 12 includes a computer generated image and a schematic toillustrate the relative positions of the haptics and non-flexible opticin the unaccommodative state using the optic holder of the invention.

FIG. 13 includes a computer generated image to illustrate radialmovement of the haptics when optic holder of the invention is used witha flexible (stretchable) optic.

DETAILED DESCRIPTION OF THE INVENTION

All patent applications, patents and other references cited herein arehereby incorporated by reference in their entirety into the presentdisclosure.

In ophthalmology, the term “haptic” refers to a support structure thatextends out from an optic element of an intraocular lens, for holdingthe lens in place within the capsular bag of the eye. For purposes ofthe present invention, “haptics” are sometimes referred to as “zonularcapture haptics” and refer to structures or material that not onlyassist with placement and centration of the lens within the capsule, butare frame-like or fenestrated structures, which permit or facilitatefusion of the anterior and posterior capsules following removal of thenatural lens and placement of the artificial lens so that the hapticsbecome securely entrapped within the fused capsule. The haptics defineindividual “sections” of the capsule which can be separated after fusionhas occurred by making radial cuts in the capsule, specifically,beginning near the center and extending out to the equator of thecapsule. Following sectioning, each haptic is contained within aseparate section of the capsule. The haptics of the optic holder of theinvention have features which specifically enable it to becomeintegrated into the fused capsule during fibrosis and then uniformlytranslate the movement that results from contraction and relaxation ofthe ciliary body to the optic.

As used herein, the term “retainer” refers to a removable rigid devicethat is utilized to maintain the IOL system in controlled state ofaccommodation during the healing, fusion period and is removed oncefusion is complete. For example, IOL systems, which rely on angulatedhaptics as a mechanism of accommodation, would be maintained in anun-accommodated state during fusion of the capsular bag; keeping theoptic holder in a flat planar configuration allows maximum contactbetween the anterior and posterior capsule to enhance fusion andeliminate distortion of the capsular bag. In a single optic system, forexample, the retainer may consist of a rigid rod with right angleextension inserting into each diametrically opposed pair of haptics. Ina double optic system, a simple suture ligation may be sufficient tomaintain the two optics in apposition to each other, reducing the angleof the posterior and anterior haptics to a flat planar configuration.For flexible, prefilled or fillable pouches, the restraining device maybe utilized to maintain the IOL system in an accommodated position toencourage the contraction of the capsular bag to a minimum diameter,thereby maximizing the ability of the IOL system to stretch duringrelaxation of accommodation after the sectioning of the capsular bag.

Such a device may be mechanical or chemical, and may be released bychemical, mechanical, laser or optical means.

As used herein, the term “fenestrated” indicates the presence of anopening or openings that allows for contact between the anterior andposterior capsule thereby facilitating fusion of the capsule through theopening(s).

Conventional accommodating lenses typically involve converting diametralmovements of the ciliary muscle into forward and backward movement of anoptic portion of the IOL relative to the retina. For example, the onlycurrently marketed accommodating IOL is a rigid, single optic IOLdesigned to rely on a forward translation of the optic to produce anincrease in optical power of the eye. Movement of the IOL is produced byciliary muscle contraction, capsular bag elasticity and/or suggestedchanges in vitreous cavity pressure to create an optical change in theeye.

However, implantation of the IOL into the capsule is followed by anatural physiological process not unlike applying a shrink-wrap film, inwhich the anterior and posterior capsular bag surfaces fuse around thehaptics and seal the IOL within the fibrotic capsule. Furthermore, thefusing capsule undergoes fibrosis. During fibrosis the bag undergoesfurther contraction and loss of elasticity. As a result of this process,the IOL is immobilized within the fibrosed capsular disc and movement ofthe optic along the optical axis is extremely limited.

The present invention is directed to an optic holder having a hapticsystem designed to restore capsular flexibility lost during fusion andfibrosis. This haptic system allows an implanted lens to transition moreeffectively between the accommodated and unaccommodated states, that is,in a fashion similar to the natural lens in response to forces appliedto the capsule by the ciliary muscle and zonules. It achieves this byemploying a haptic system that is flexible and becomes securelyintegrated into the fused capsular disc and allows for the capsular discto be cut into sections, which has the effect of reducing the rigidityof the fused capsular disc and allows the optic holder to expand.

The present invention, therefore, is directed to a flexible optic holdercomprising a plurality of haptics arranged in a circle and extendingoutwardly from a center portion of the optic holder (see FIGS. 1a and 1b). In addition to providing centration of the optic within the capsulelike the haptics in conventional intraocular lenses, the haptic systemof the optic holder of the present invention provide closed-loop,frame-like structures that allow contact between the anterior andposterior capsules so that the process of capsular fusion and fibrosisare not impeded, thereby creating a skeletal support for the capsulardisc. The natural post-phacoemulsification healing process is importantfor integration of the haptics into the capsular disc. Furthermore, thehaptics are regularly arranged around the optic holder ring with a spacebetween adjacent haptics to permit the fused capsular disc to be cut atregular intervals.

The haptics of the optic holder of the invention may be rigid orsemi-rigid structures and may be made from a generally continuouselement or a single continuous element of varying widths or thicknessesas long as the ability of the anterior and posterior capsules tosecurely fuse through the haptic is preserved. Haptics are made of asuitable nonabsorbable surgical material such as surgical wire, sutureor the like. In one embodiment, haptics are constructed of polypropylenesuture material, such as Prolene® (Ethicon, Somerville N.J.) The hapticsof the optic holder may optionally include additional structures withinthe haptic frame, such as cross bars or anchors (for example, as shownin FIG. 1), to reinforce the haptic within the capsule following fusion.Anchors may be T-shaped, or a grid with cross-members that cross thelength and/or width of the haptic.

The present invention also provides a two-stage process for insertinginto an eye the intraocular lens system of the invention to achieve animproved level of accommodation. In one embodiment, evacuation of thecapsular bag is followed by placement within the capsular bag of anoptic holder that comprises one or more haptics that define acapsule-reinforcing disc and which will ultimately receive the optic ofthe IOL system. Implantation of the haptic is followed by a healinginterval, that is, a period of time sufficient to allow the anterior andposterior capsular bag surfaces to fuse together through and around thehaptics of the optic holder thereby sealing the haptics within thefibrotic capsule. In one embodiment of the method, fusion of thecapsular bag around the haptic occurs under conditions in which ciliarybody movement is restricted, for example, by atropine-inducedcycloplegia or pilocarpine-induced accommodation; paralysis ofaccommodation movement optimizes capsular disc size, and enhancesfibrosis of the capsule. Alternatively, mechanical means for maintainingthe capsule in the unaccommodative or accommodative state, for example aretainer, may be employed to achieve the desired capsular disc size. Theabsence of an accommodating optic during the phase of capsular fusionallows the optic holder to be free of mechanical strain and capsular bagdistortion during the fusion and fibrosis period.

During the second stage the capsular disc and incorporated haptics aresectioned to reduce the rigidity of the capsular bag so that the forceexerted by the zonules can more effectively be transmitted to thecapsule and permit movement of the optic along its optical axis and inthe case of flexible optics, accommodative and unaccommodative movementcaused by contraction of the ciliary muscle and/or zonular tension. Cutsare made radially and at regular intervals between the haptics, (seeFIG. 3) extending from the visual axis to the equator of the capsulardisc. The accommodating optic may be inserted into the ring of the opticholder at the time of sectioning, either before or after sectioning. Theoptic contains means for securing the optic into the lens holder, forexample a circumferential releasable connecting rib or series ofreleasable connecting tabs, pins, plugs or the like that snap into acorresponding receptacle: a groove, notch or hole on the inner edge ofthe haptic.

The intraocular lens system of the invention comprises a rigid orflexible optic, single lens or multiple lenses, or fillable orpre-filled, and in one embodiment, an accommodating optic and opticholder are inserted as a single unit at the time of initial cataractsurgery. Such an integrated intraocular lens system may include arestricting device to mechanically or chemically maintain the system ina specific state of accommodation during the fusion and fibrosis of thecapsular disc, for example a maximally accommodated optic andpilocarpine-induced pharmacologic accommodation during the entireduration of capsular fibrosis and fusion. This eliminates mechanicalstrain or movement or distortion of the capsular bag during thefusion/fibrosis phase after the first stage procedure, optimizing thesize of the fibrotic capsular disc, sealing of the haptic members in thecapsular disc and resting tension on the zonules.

During the second stage, radial cuts are made in the capsular disc,between the haptics, and extending from the visual axis to the outeredge of the capsular disc. This releases the restraining effect offibrosis on the now segmented, capsular bag. An optic restrainingdevice, if employed, is also removed at this time allowing theaccommodating optic to respond to the zonular tension transmitted by thehaptics during relaxation of accommodation, or to return to its restingaccommodating state during contraction of ciliary body and relaxation ofthe zonules.

The method of the present invention for the implantation of anintraocular lens, therefore, includes making a plurality ofregularly-spaced radial cuts around the capsule/haptics, extending fromthe visual axis to the edge of the capsular bag. Sectioning alters therigidity of the capsule following capsular fibrosis/fusion so that thetension and relaxation of the zonules is more effectively translated tothe capsule thereby enhancing spatial displacement of the opticalelement.

Uniform and complete natural, therapeutically-assisted or -enhancedfusion of the capsule around the haptic prior to optic placement ensuresuniformity of sectioning essential to centration and stability of theoptic once it is inserted.

Following insertion, the patient undergoes a recovery period of one tosix weeks, preferably two to three weeks, for complete fibrosis of thecapsule to occur. A second surgical procedure is performed to restore“elasticity” to the capsule by making radial incisions in the capsule atregular intervals forming roughly triangular or trapezoidal sections,each of which contains one of the haptics of the optic holder.

By “sectioning” the capsular disc, greater movement of the optic alongthe optical axis is achieved. Each haptic-reinforced section of thesectioned disc is generally separate from the others, held together bythe inter-haptic connectors of the lens holder and the optic, when it ispositioned within the optic holder. As a result of the sectioning,however, the force generated by the zonules is more effectivelytransmitted to the optic.

It is hypothesized that a 1 mm change in capsular bag diameter resultsin 2 mm anterior/posterior optic movement. A 12 mm capsular bag underzonular tension, (i.e. unaccommodated) collapsing to 11 mm in diameteras a result of the AIOL tension will result in a 2 mm anteriordisplacement during accommodation. Expected ranges of totalaccommodation with rigid single and double optics and flexibledeformable optics are shown in Table 1.

TABLE 1 Single Optic Dual Optic Flexible Optic Actual 2D 6D 4-7Daccommodation Pseudo 1.5-2D 1.5-2D 1.5-2D accommodation Total 3.5-4D7.5-8D 4.5-9D accommodation

Intraocular Lens System

The intraocular lens system of the invention comprises 1) a flexibleoptic holder specifically adapted to permit fusion of the capsule andsectioning of the capsular disc once fusion is complete and 2) an optic.The optic holder comprises a plurality of haptics adapted to receive andsecure the optic(s). The optic holder supports the optic around itsequator and couples the optic to the capsular bag of the eye. Followingextraction of the natural lens and placement of the flexible opticholder of the invention into the capsular bag, the natural healingprocess causes the optic holder to become entrapped, “capturing” thecapsule, when the anterior and posterior leaves of the capsular bag fusetogether. Subsequently, radial cuts to the capsule allow the sections ofthe fused capsule and the captured haptics to move independently of theothers in response to zonular tension.

Optic Holder with Zonular Capture Haptics

The intraocular lens of the invention comprises a optic holder withzonular capture haptics, that is, haptics, which by their closed-loopdesign, allow maximal fusion of the anterior and posterior capsulethrough the haptics and permit the capsule to be sectioned followingfusion, so that, in response to tension by the zonules, each haptic isable to move radially away from the center of the optic holder and thenreturn to the initial position when zonular tension is released. Thehaptics become fused within the capsular bag and enables the capsule tobe sectioned into a plurality of capsular “sections.” The hapticsprovide fixation, centration and stability of the optic(s) within theeye and provide a skeletal support for the capsular bag so that itsrigidity can be reduced by cutting it into sections.

One embodiment of an optic holder of the present invention is shown inFIG. 1. Optic holder 10 comprises a plurality of haptics 20 extendingoutwardly from the center of optic holder 10. The arrangement of haptics20 generally defines a ring that receives an optic 80, and haptics 20further comprise optic attachment means 50/52 to hold the optic 80securely in place. In this embodiment, haptics 20 are roughlytrapezoidal in shape. Adjacent haptics 20 are connected via aninter-haptic loop or connector 30 of flexible material so that the inneredges of haptics 20 form a continuous ring to which the optic isultimately attached.

In some embodiments, optic holder 10 is flexible (FIG. 1b ). The haptics20 are spaced apart at regular intervals to generally form a disc thatis roughly coextensive in size with the capsular bag and retains thecircular shape of the fused capsular disc. Following placement of anoptic holder of the invention into the capsular bag, the capsule willshrink and fuse around the optic holder (much like shrink-wrap). Asshown in FIG. 2b , once fusion of the capsule is complete, cuts are madebetween the haptics of the optic holder. This allows the sections tomove somewhat independently of each other.

FIG. 2a shows an embodiment of an optic holder of the invention withinthe unsectioned capsular bag (shaded area). Following sectioning betweenhaptics (FIG. 2b ), the optic experiences improved freedom of movement,compared to the unsectioned capsule in response to zonular tension.

In FIG. 3, the positions of the haptics and optic of any intraocularlens, including conventional intraocular lenses, once the capsule hasfused and become fibrosed are shown in the upper panel. The bottom panelshows anterior movement of the optic (shown as downward movement) madepossible by sectioning the fused capsule using the optic holder of thepresent invention.

FIG. 4a shows an embodiment of an optic holder 100 in which an optic 180has been secured prior to sectioning of the capsular bag; sectioninglines 184 are indicated. The position of the optic 180 and haptics 120during accommodation (4 b) and the unaccommodative state (4 c) areshown.

FIG. 5 shows an embodiment of optic attachment means 52/50, for example,a pin 52 and receptacle 50 snap-like fastener, by which optic 80 issecured in optic holder. Because the haptics are angulated, without anyother force in play, insertion of the optic into the holder forces thehaptic into a roughly 30° angle with the optic.

In one embodiment (see FIGS. 6 and 7), a pair of anteriorly- andposteriorly-angled optic holders are used in an alternating arrangementor configuration. The anterior haptic will receive an anterior optic,while the posterior one will receive a posterior optic. In thedual-optic system, during accommodation, zonular tension is released andthe haptic system returns to its resting state of maximum angulation ofthe optic attachment means causing the two lenses to move axially awayfrom each other, thereby providing increased accommodative amplitude.

When tension is applied to the optic holder during relaxation of ciliarybody, the haptics straighten thereby causing an axial displacement ofthe optics towards each other (as shown in FIG. 7c ). With a dual-opticsystem, maintenance of the appositional relationship of anterior andposterior optics is important to ensure uniform fusion of the capsule.This may be achieved mechanically or through the use of therapeuticagents that induce unaccommodation.

Referring to FIG. 8, in one embodiment, the optic holder 300 comprisesan optic 380 or optic holding member at its center and a singledoughnut-shaped haptic 320 extends outwardly from the optic 380 and ismade of a woven material or mesh or fenestrated material that 1) permitsfusion of the capsular bag and 2) can be sectioned or cut. Radialsectioning lines (not shown) may be indicated on the capsule-capturehaptic and small holes near the optic/optic holding member provided forstarting the cut.

FIG. 9 shows an embodiment in which haptics 420 and optic 480 comprise asingle unit, with a flexible optic 480, or fillable or prefilled opticpouch attached directly to the haptics 420. Such an optic has apredetermined dioptric power in its resting state (9 b). The inherentoptic elasticity allows stretching of the optic equator and flatteningof the lens curvature in the un-accomodative state (9 c) and return to amore spherical shape (9 b) during accommodation when zonular tension isreleased.

Flexible optics, fillable or prefilled optic pouchs are known in the artand can be integrated or adapted for use with the optic holder of theinvention. The adaptation of any elastic optic embodiments to a zonularcapture optic holder would enable the optic to change shape andaccommodate.

In some embodiments, the haptics further comprise an anchor or othersupport structure for promoting fusion/fibrosis of the capsular bag andintegration of the haptic within the capsular bag. The anchor may be anyshape, for example, T-shaped, or size which will have the effect ofsecuring and reinforcing the haptic within the capsular bag.

Implantation of the Optic Holder

In an initial procedure, the optic holder is placed in the capsular bagof the eye, and the anterior and posterior leaves of the capsular bagare allowed to fuse together securing the optic holder within the fusedcapsular bag or disc. Uniform healing of capsule around optic holderensures centration of the optic once it is placed in optic holder.

In a second procedure, a number of cuts are made in the capsular discbetween the haptics of the optic holder. The cuts extend from the visualaxis to the outer edge of the capsular disc. Additionally, the posteriorzonules may become stiff further limiting anterior/posterior movement.In some situations, it may be desirable to cut the posterior zonules.

In one embodiment, the optic holder comprises a ring structure in whichat least three capsule-capture members (haptics) extend outwardly fromthe center of the ring (see FIG. 1). The number and size ofcapsule-capture members of the optic holder varies depending on thenumber of sections which the clinician determines to be optimal. In sodetermining, an optimal number of sections may be determined to be thatnumber which will permit the greatest axial movement of the optic thatcan be achieved without compromising the integrity of the capsular bag.Further considerations regarding the number of sections to be madeinclude allocating an amount of time for sectioning which the clinicianfeels is appropriate for the safety and well-being of the patient.

The haptics of the optic holder are made from inert or biocompatiblematerials known to those of skill in the art, for example, silicone,polypropylene, acrylic polymers or the like. Haptics are made in an openconfiguration (loops), and may be of any shape, for example, generallytriangular or trapezoidal, which, as a group roughly define a disc thatis coextensive with the capsular bag. Generally, the outer edge of thehaptics extend to the equator of the capsular bag to form acapsule-reinforcing disc which is roughly coextensive with the capsulardisc, and by virtue of their shape or porosity, permit fusion of theanterior and posterior leaves of the capsular bag to form a capsulardisc encasing the haptic.

The number and configuration of individual members are chosen inaccordance with considerations discussed supra to anchor theoptic-holder ring in the capsular bag and form an internal “frame” onwhich the fused capsular disc is supported. To maximize or minimize thediameter of capsular bag during fusion thereby impacting the ultimatesize of the fused capsular disc, accommodation can be controlled duringfusion of the capsular bag by administration of an agent to inhibit orinduce accommodation.

Optics

The intraocular lens system of the invention may comprise multiple lensholders and therefore, be able to hold one or more optics. Optics aregenerally symmetrical about the optical axis. Examples of suitableoptics are well known in the art and can be adapted for use with theoptic holder and zonular capture haptics of the invention. These includeoptics that are flexible, deformable, foldable, or rigid, preformed orfillable and which are made from a liquid, solid or semi-solid material.In one embodiment, if a flexible optic is used, it can assist inaccommodation not only by anterior-posterior displacement, but also bychanging its radius of curvature.

Examples of suitable optic materials include silicone(s), acrylics,hydrogels and other inert or biocompatible polymers known to those ofskill in the art. In one embodiment, the optic comprises a means forsecuring the optic into the haptic, for example a circumferentialreleasable connecting rib or series of releasable connecting tabs orpins that snap into a corresponding groove, notch or hole on the haptic.

Haptics may incorporate any means suitable for attaching and securingthe optic; these are well known in the art.

Sectioning of capsular disc after fusion and fibrosis of the haptictherein can be accomplished by virtue of a small gauge (for example, 23or 25 gauge) trans-conjunctival vitrectomy system with trocars andcannulas placed diametrically opposed to the section line in thecapsule/haptic where the section is to be made. A small gauge (forexample, 23 or 25 gauge) scissor is introduced through a cannula andused to cut the capsule from the visual axis to the outer edge of thecapsular disc.

While several aspects of the present invention have been described anddepicted herein, alternative aspects may be effected by those skilled inthe art to accomplish the same objectives. Accordingly, it is intendedby the appended claims to cover all such alternative aspects as fallwithin the true spirit and scope of the invention.

A haptic arrangement was manufactured from 4-0 surgical Prolene sutureswith 7-0 surgical Prolene retention bands (FIG. 10). The function of theretention bands are to maintain the shape of each haptic loop, tofunction as an additional retaining anchor within each haptic and tomaintain the distance between the haptics during the sterilizationprocess. The surgical procedure for implantation of an optic holder ofthe invention consists of two stages.

All procedures related to the use of animals conform to the Guide forthe Care and Use of Laboratory Animals (National Institutes of Health,National Research Council) and are approved by the Wisconsin NationalPrimate Research Center. The animals are housed in facilities accreditedby the Association for Assessment and Accreditation of Laboratory AnimalCare International (AAALAC). Animal subjects are paired or individuallyhoused. Diet consists of monkey chow supplemented with fresh fruit andvegetables. Water is freely available. All animals are observed daily bya veterinary technical staff and caretakers for signs of ill health.

Adult Rhesus monkeys (Macacca mulatta) of either sex without any oculardisease, are the subjects of the following experiments.

At Stage 1, the treated eye is rendered aniridic by complete surgicalremoval of the iris. The absence of the iris facilitates evaluation ofthe optic holder's performance. Standard cataract removal by small,clear corneal incision and phacoemulsification is followed byimplantation of the lens holder of the invention via standard 2 mm lensinjector (Photo 2). The treated eye is maintained in a pharmacologicstate of forced accommodation by the administration of pilocarpine drops4 times per day. This allows the zonules to be free of tension duringthe healing, fibrosis, contracture phase of the capsular bag. A minimumcapsular disc size is thus obtained, which is anticipated to securelyincorporate the haptics of the lens holder in between the fused anteriorand posterior capsules. Once the fibrosis phase is complete,approximately 2-4 weeks after the Stage 1 surgery, the animal isanesthetized again for the Stage 2 surgery.

A 23 or 25 gauge standard vitrectomy instrument is employed. Fourtrans-conjunctival cannulas are inserted at the standard pars planalocation, coinciding with the planned capsular section lines as definedby the location of the spaces between the haptics. A central posteriorcapsulotomy is performed with the vitrectomy instrument. A 23 or 25gauge Vitreoretinal scissor is introduced via each cannula to performradial cuts extending from the edge of the posterior capsulotomy to theequator of the capsular bag, cutting across the fused capsular sheets,the 7-0 Prolene suture extending in between capsular members, to theedge of the capsular disc, ensuring that no connection remains betweenthe individual sections of capsular disc capsule. The only connectionbetween the sectioned capsules and entrapped haptics is the flexibleinter-haptic loop extending from one haptic to the next.

Administration of pilocarpine drops is discontinued postoperatively.Once the eye has recovered from the surgical intervention, the eye ischallenged with pharmacologic accommodation and relaxation ofaccommodation under anesthesia with short acting pharmacologic agentswhile the eye is monitored and videographed. It is anticipated thatduring relaxation of accommodation, zonular tension is produced andtransmitted to the individual segments of the former capsular disc,which now move independently. Each haptic of the optic holder shouldmove centrifugally and away from each other. When accommodation isinduced pharmacologically, the tension of the zonules is released andthe elasticity of the inter-haptic loops returns haptics to a closerconfiguration. A change in diameter of the optic holder of up to 1 mm isexpected, based on previously published data.

1-17. (canceled)
 18. An intraocular lens system comprising: an opticholder comprising a plurality of radially disposed haptics adapted tomove independently in response to forces of at least one of a ciliarymuscle and zonules of an eye when implanted.
 19. The optic holder ofclaim 18, wherein said haptics are regularly spaced defining sectioningintervals therebetween.
 20. An optic holder comprising a single annularhaptic adapted to move in response to forces of at least one of aciliary muscle and zonules of an eye when implanted.
 21. The opticholder of claim 18, where said plurality of haptics comprises at leastthree outwardly extending haptics.
 22. (canceled)
 23. (canceled)
 24. Theoptic holder of claim 18, wherein said haptics are closed-loop, therebyallowing fusion of the capsular bag through the haptics so that thehaptics become fixed within the capsular bag.
 25. The optic holder ofclaim 21, wherein said haptics are rigid or semi-rigid.
 26. The opticholder of claim 21, where said plurality of haptics comprises no morethan 120 haptics.
 27. The optic holder of claim 20, wherein said hapticcomprises cutting lines indicated thereon.
 28. The intraocular lenssystem of claim 18, further comprising: an optic coupled to theplurality of haptics.
 29. The intraocular lens system of claim 18,further comprising a restricting device configured to maintain thehaptics in a specific state of accommodation.
 30. The intraocular lenssystem of claim 18, further comprising a retainer adapted to achieve adesired capsular disc size.